Participants completed self-report measures covering death anxiety, PTSS, adaptive and maladaptive cognitive coping, previous adverse life events, and exposure to ongoing security-related events. The researchers examined whether cognitive coping was indirectly related to the association between death anxiety and PTSS severity and whether that pattern differed according to the level of prior adversity. In the reported model, greater use of maladaptive cognitive coping was associated with an indirect link between death anxiety and PTSS severity. Adaptive coping was not related to PTSS severity, and no indirect association through adaptive coping was detected. The design does not establish the temporal order of these variables, nor can it determine whether maladaptive coping contributes to distress, develops in response to distress, or is associated with both through other factors.

The analysis also identified a non-linear relationship linking prior adverse life events, death anxiety and adaptive coping. At low levels of prior adversity, higher death anxiety was associated with greater adaptive coping. At high levels, the direction reversed: higher death anxiety was associated with lower adaptive coping. The authors therefore characterized cumulative life adversity as a conditional correlate of adaptive coping rather than a uniform correlate. The finding does not support labeling adaptive coping as protective, because it was not associated with PTSS severity in the primary analysis, and the study did not measure whether coping responses changed over time.

The proposed moderated mediation was not supported for the primary outcome of PTSS severity because adaptive coping was not related to that outcome in the main analysis. An exploratory supplementary analysis using a continuous complex-PTSD score did support the moderated-mediation model. This distinction is important: the complex-PTSD result came from a supplementary analysis and a different scoring approach, whereas the primary PTSS analysis did not support the full model. The authors noted that maladaptive cognitive coping may warrant attention as a potential intervention target in contexts of sustained insecurity, but the research did not test an intervention or demonstrate clinical benefit. The findings instead provide a cross-sectional account of the cognitive variables statistically associated with death anxiety and posttraumatic stress among this sample of adults facing prolonged security-related threat.

Subject of Research: Cognitive coping, life adversity, death anxiety and posttraumatic stress symptoms under prolonged security threat

Article Title: Death anxiety and posttraumatic stress under ongoing security threat: the role of cognitive coping and life adversity

Article References: Moshe, S., & Hamama-Raz, Y. (2026). Death anxiety and posttraumatic stress under ongoing security threat: the role of cognitive coping and life adversity. Current Psychology, 45(21), 1637. https://doi.org/10.1007/s12144-026-10136-2

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10136-2

Keywords: death anxiety, posttraumatic stress symptoms, maladaptive coping, adaptive coping, life adversity, security threat, cross-sectional study, self-report measures, Death, anxiety, posttraumatic, stress

The study population consisted of caregivers of 360 people receiving treatment at the psychiatry outpatient clinic, with 150 caregivers included in the final sample. The research examined the relationship between caregiver burden and death anxiety within this clinic-based population. Caregiving for people with psychiatric disorders may create emotional, physical, and social demands, and the findings connect the burden experienced by caregivers with elevated death anxiety. The result is an association rather than evidence that one of the two variables directly causes the other.

The researchers also found that caregiver burden and death anxiety differed according to several caregiver characteristics. The supplied study summary does not identify those characteristics or specify which groups had higher or lower values, so the results do not support conclusions about differences between particular types of caregivers. It also does not provide details about the measurement instruments, recruitment procedures, or uncertainty intervals for the regression analysis. Those omissions limit the extent to which readers can assess how the variables were assessed and how precisely the reported association was estimated.

Based on the results, the authors recommend regular support and psychoeducation programs for caregivers of people with psychiatric disorders. They also recommend home-based health services when necessary and regular social-support interventions intended to reduce death anxiety. Involving caregivers in treatment and support programs for people with psychiatric disorders may strengthen family support and contribute to better caregiving outcomes. The study reports these as proposed responses to the observed relationship; it does not test or demonstrate the effectiveness of those interventions. Overall, the research identifies a statistically significant link between moderate caregiver burden and high death anxiety among the participating caregivers, with burden explaining 30.7% of the variance in the latter measure.

Subject of Research: The association between caregiver burden and death anxiety among caregivers of people receiving psychiatric outpatient treatment.

Article Title: The relationship between caregiver burden and death anxiety among caregivers of people with psychiatric disorders

Article References: Kaçan, H., Savaş, S., & Değer, V. B. (2026). The relationship between caregiver burden and death anxiety among caregivers of people with psychiatric disorders. BMC Psychology. https://doi.org/10.1186/s40359-026-05553-8

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05553-8

Keywords: caregiver burden, death anxiety, psychiatric disorders, family caregivers, outpatient care, linear regression, psychoeducation, social support, mental health, relationship, between, caregiver

The starting point for the debate is the 2016 consensus paper, also published in Supportive Care in Cancer, in which Lebel, Ozakinci, Humphris, Mutsaers, Thewes, Prins, Dinkel, Butow and colleagues at the University of Ottawa Fear of Cancer Recurrence Colloquium defined fear of cancer recurrence as a normal response moving toward a clinical problem. That definition deliberately covered a spectrum, from the fleeting worry that nearly every survivor experiences after a scan or an anniversary date, to the severe, persistent and intrusive fear that can dominate a person’s life and function as a psychological disorder. By folding both recurrence, meaning the return of disease after treatment, and progression, meaning the advance of existing disease, into a single slash-linked construct, the field gained a shared language but may have blurred important clinical distinctions.

The scale of the problem explains why the construct matters so much. A systematic review and individual participant data meta-analysis published in 2022 in Psycho-Oncology, with Luigjes-Huizer, Tauber, Humphris, Kasparian, Lam, Lebel, Simard, Smith, Zachariae, Custers and many collaborators among its authorship, estimated the prevalence of fear of cancer recurrence across cancer survivors and patients and confirmed that it is widespread, affecting a substantial minority at clinically significant levels. Psychological interventions have been developed in response, and a 2019 meta-analysis in the Journal of Clinical Oncology led by Tauber and colleagues showed that these treatments do reduce fear, although effect sizes were modest, leaving considerable room for refinement. It is precisely that refinement, the new commentary argues, that may require a sharper conceptual toolkit.

The technical heart of the argument lies in psychometrics and construct validity. The Fear of Cancer Recurrence Inventory, developed and validated by Simard and Savard in 2009, established a multidimensional measure that has anchored assessment for more than fifteen years. More recently, however, Coutts-Bain, Sharpe and colleagues published a study in Psycho-Oncology in 2022 asking directly whether fear of cancer recurrence and fear of progression are equivalent constructs, and a 2023 study in the Journal of Behavioral Medicine showing that death anxiety predicts both fear of recurrence and fear of progression in ovarian cancer patients over and above other cognitive factors. These findings suggest that the two fears share common psychological machinery, particularly cognitive avoidance and worry processes described in the cognitive avoidance theory of worry cited by the commentary, while also hinting that they may diverge in clinically meaningful ways.

That divergence becomes most visible in the context of advanced disease. For patients living with metastatic cancer on ongoing systemic treatment, the binary of recurrence versus no recurrence simply does not apply. A 2022 scoping review in Cancers by Kolsteren, Deuning-Smit, Chu and colleagues examined the psychosocial aspects of living long term with advanced cancer and ongoing treatment, and a 2024 international modified Delphi study published in the Journal of Psychosocial Oncology Research and Practice, again led by Kolsteren with Kwakkenbos, Prins, Sharpe, Lebel and Custers, formally identified the features of fear of progression in this population. The experiences described there, including uncertainty about how long a treatment will keep working, vigilance toward every scan and every blood marker, and the challenge of holding hope and mortality in mind simultaneously, differ in kind from the fear of a cured patient that the disease might silently return.

Precision medicine has amplified this mismatch. Targeted therapies and immune checkpoint inhibitors have transformed some advanced cancers into chronic conditions managed over years. Research on the survivorship experience of patients with metastatic melanoma on immune checkpoint and BRAF-MEK inhibitors, published in the Journal of Cancer Survivorship in 2019 by Lai-Kwon, Khoo and colleagues, documented how these patients live in a permanent state of surveillance, dependent on drugs whose durability is uncertain. In such a world, the question is not whether the cancer will come back but whether the current therapy will continue to hold it in check. A construct defined around recurrence after curative treatment struggles to capture that existential position, which is closer to what psychotherapy researchers such as Colosimo, Nissim, Pos, Hales, Zimmermann and Rodin have described as double awareness in patients living with advanced cancer.

The commentary also situates the debate within a broader transdiagnostic movement. Sharpe, Michalowski, Richmond, Menzies and Shaw published a systematic review and meta-analysis in Health Psychology Review in 2023 demonstrating that fear of progression occurs in chronic illnesses other than cancer, treating it as a transdiagnostic construct that cuts across diagnostic categories. If fear of progression is a general phenomenon of chronic illness, while fear of recurrence is more specific to the cancer survivorship trajectory, then merging the two may obscure both their shared mechanisms and their distinct triggers. The measurement field has begun to respond: Sharpe, Menzies, Richmond, Todd, MacCann and Shaw developed and validated the Worries About Recurrence or Progression Scale, known as WARPS, in the British Journal of Health Psychology in 2024, and Smith, Sharpe, Winiarski and Shaw followed with a cancer-specific version, WARPS-C, validated in Psycho-Oncology as a screening tool for fear of cancer recurrence.

What would separation actually mean in practice? The authors suggest that distinguishing the two constructs could sharpen screening, since the questions that detect fear of recurrence in a disease-free survivor may not detect fear of progression in a patient on maintenance therapy. It could also refine treatment selection, because interventions that target catastrophic misinterpretation of bodily symptoms, a core driver of recurrence fear in survivors, may need different emphasis from interventions that help patients with advanced disease tolerate uncertainty and balance awareness of dying with engagement in living. Furthermore, separating the constructs would allow researchers to test whether death anxiety, which the ovarian cancer data identified as a powerful predictor, plays a larger role in progression fear than in recurrence fear, with direct implications for which therapeutic techniques should be deployed for which patients.

The commentary does not claim that the field should abandon a decade of accumulated evidence, and its authors, who wrote the original draft together and revised it with the full international group, are careful to frame the question as one for the community to weigh. The original 2016 definition succeeded in legitimizing fear of cancer recurrence as a clinical problem worthy of research funding, validated instruments and psychological trials. The risk now, they imply, is that a construct built for the curative-treatment era is being stretched across patient populations whose clinical realities it was never designed to describe. As precision medicine continues to convert advanced cancer into a long-term managed disease, the psychological sciences of oncology may need vocabulary that keeps pace, and the question posed by Custers, Lebel, Sharpe and their colleagues is likely to shape the next round of consensus discussions about how fear of cancer returning, spreading and progressing should be defined, measured and treated.

Subject of Research: Distinguishing fear of cancer recurrence from fear of progression in psycho-oncology

Article Title: Rethinking fear of cancer recurrence/progression in the era of precision medicine: is it time to consider separating?

Article References: Custers, J. A. E., Chu, A., Smith, B., Dinkel, A., Humphris, G., Ng, D. W. L., Prins, J. B., Poort, H., Braam, C. I. W., Kemme, N. D. F., van der Lee, M. L., Zwanenburg, L. C., Schellekens, M. P. J., Sharpe, L., & Lebel, S. (2026). Rethinking fear of cancer recurrence/progression in the era of precision medicine: is it time to consider separating?. Supportive Care in Cancer, 34(10), Article 985. https://doi.org/10.1007/s00520-026-11233-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11233-5

Keywords: fear of cancer recurrence, fear of progression, psycho-oncology, precision medicine, cancer survivors, advanced cancer, psychometrics, death anxiety, WARPS scale, supportive care, construct validity, cancer survivorship

The methodological approach was deliberately exploratory and qualitative. Rather than distributing questionnaires and crunching numbers, the researchers conducted semi-structured interviews with healthcare students and professionals, allowing participants to speak at length and in their own words about death, dying, and the support offered to families. The interview transcripts were then analyzed thematically using IRAMUTEQ, a free software package that interfaces with the R statistical environment to perform multidimensional analyses of textual data. This kind of computer-assisted lexical analysis allows researchers to identify recurring word clusters and thematic worlds within large bodies of text, providing a systematic and reproducible way to map what participants emphasized, avoided, and connected. The choice of method matters: perceptions of death are slippery, culturally loaded, and often unspoken, and a purely quantitative instrument might have flattened exactly the nuances the team was trying to capture.

What the analysis revealed was a set of interlocking limitations that participants described as shaping, and often constraining, the care they could provide. The first was educational. Participants reported that their formal preparation for end-of-life care was inadequate, a finding that echoes a substantial international literature. Systematic reviews of undergraduate palliative care teaching across Europe, China, Latin America, Austria, and New Zealand have repeatedly documented that palliative medicine occupies a marginal place in medical and nursing curricula, and surveys of students consistently show low confidence and limited knowledge when it comes to managing dying patients. The Portuguese participants in this study experienced that gap firsthand, describing a professional world in which they were expected to accompany patients through the most difficult passage of their lives with little structured guidance on how to do it.

The second limitation was structural. Participants pointed to resource constraints that made high-quality end-of-life care difficult to deliver, a complaint that resonates with reports from the Portuguese Palliative Care Association, which has warned that significant gaps in palliative care provision persist in Portugal alongside institutional inertia to resolve them. Access barriers to palliative services in hospitals have been documented in mixed-methods systematic reviews across multiple countries, and studies of nursing practice in palliative settings have even identified the self-rationing of care, in which nurses quietly triage which needs they can address because time and staffing fall short. In other words, the problem the Porto team identified is not simply a matter of individual skill or will; it is embedded in systems that ask clinicians to perform emotionally and technically demanding work without adequate tools, personnel, or institutional backing.

The third and perhaps most psychologically charged limitation concerned communication. Participants described barriers to talking honestly with dying patients and their families, a difficulty that clinicians around the world will recognize. Research on end-of-life discussions in oncology has documented both actual and missed opportunities for these conversations, and qualitative work on breaking bad news has shown a persistent disconnect between what is taught in classrooms and what students feel prepared to do at the bedside. Talking about death forces clinicians to confront their own mortality, a dynamic long theorized in terror management research, and many default to avoidance, euphemism, or technical language that shields them as much as it confuses families. The participants in the Portuguese study were candid that this avoidance damages the therapeutic relationship precisely when it matters most, leaving patients and loved ones uncertain, unprepared, and sometimes unable to say the things that give dying its meaning.

Hand in hand with communication barriers came the fourth limitation: difficulty managing emotions. Caring for terminal patients is not emotionally neutral work, and the participants described the strain of witnessing suffering and death without adequate psychological support or training in emotional regulation. The wider literature is unambiguous about the stakes. Studies of oncology nurses have linked repeated exposure to patient death with secondary traumatic stress, moderated in part by empathy, and cross-sectional research has connected confrontation with suffering and death to burnout and diminished wellbeing among professionals. Qualitative studies of nursing home staff describe the emotional labor of closing the door, wiping away sadness, and putting on a smiling face. A recent scoping review has even described professional grief in healthcare as hidden in plain sight, an experience so routine that institutions rarely acknowledge it. The Porto participants’ struggles, in this light, are not personal failings but predictable responses to an occupational reality that healthcare systems have chosen not to address.

Woven through all of these themes was the family. Participants emphasized that end-of-life care is never delivered to a patient in isolation; it is delivered to a web of relatives who are frightened, exhausted, and often unprepared for what is coming. International qualitative research has described family involvement in end-of-life care as work that someone must do, frequently falling to relatives without training or support, and integrative reviews have shown that interventions promoting family participation measurably enhance the quality of care for hospitalized patients. The Portuguese participants recognized that supporting families requires its own distinct set of communication and emotional skills, distinct from those needed for the patient, and that these too were absent from their education. When clinicians cannot manage these conversations, the burden shifts silently onto families, who must navigate the dying process with even less preparation than the professionals at the bedside.

The study’s authors argue that these findings point directly toward a solution: targeted educational programs that equip healthcare professionals and students with concrete skills in communication and emotional regulation. The evidence base for such training is genuinely encouraging. Systematic reviews of intervention trials for healthcare professionals have found that palliative care training programs can be effective, and meta-analyses of randomized controlled trials teaching palliative care to health professional students support the value of structured education. Educational interventions ranging from death preparation programs for nurses to simulation-based communication training and blended-learning courses on discussing approaching death have shown measurable improvements in death anxiety, attitudes toward end-of-life care, and perceived competence. Interprofessional education programs and student Schwartz rounds, which bring multidisciplinary teams together to discuss the emotional dimensions of care, represent additional promising formats. The Porto team’s training program is conceived as a response to the specific gaps their participants named, grounded in the actual language and concerns of the clinicians and students who will use it.

What makes this study resonate beyond Portugal is how faithfully it mirrors a global condition. The Lancet Commission on the Value of Death argued in 2022 that death has been too thoroughly medicalized and must be brought back into life, into homes, communities, and honest conversation. The experiences recorded in this Portuguese study, from the first patient death a nursing student witnesses to the seasoned professional’s quiet exhaustion, illustrate exactly what happens when that commission’s warning goes unheeded at the level of individual training. Medicine has become extraordinarily adept at prolonging life, but the skills of accompanying death, of speaking plainly with the dying and holding space for their families, remain treated as optional extras rather than core competencies. The result is a workforce that describes itself as unprepared for one of the most meaningful tasks it will ever perform.

The researchers are careful about the limits of their design. An exploratory qualitative study with semi-structured interviews cannot quantify the prevalence of these perceptions or establish causal relationships between training deficits and care quality, and the findings are shaped by the specific context of Portuguese healthcare education and by the participants who chose to speak. Data from the study are available upon reasonable request from the corresponding author, and the work received ethics approval from the Faculty of Psychology and Education Sciences at the University of Porto, with all participants providing written informed consent. Yet the convergence between these interview findings and the international quantitative literature gives the conclusions considerable weight. If the study’s central recommendation is taken seriously, the payoff could be substantial: clinicians who can talk about dying without flinching, who can regulate their own grief while remaining present, and who can extend genuine support to families, transforming the end of life from a medical failure to be managed into a human passage to be accompanied with skill and compassion.

Subject of Research: Healthcare students' and professionals' perceptions of end-of-life care, family support, and palliative care education

Article Title: Healthcare Students’ and Professionals’ Perceptions on Care and Education in End-of-Life and Family Support

Article References: Neto, A., Neto, F., & Costa, P. (2025). Healthcare Students’ and Professionals’ Perceptions on Care and Education in End-of-Life and Family Support. Trends in Psychology. https://doi.org/10.1007/s43076-025-00506-3

Image Credits: AI Generated

DOI: 10.1007/s43076-025-00506-3

Keywords: palliative care, end-of-life care, healthcare education, qualitative research, communication, emotional regulation, nursing, death anxiety, family support, medical training, burnout, Portugal

The study recruited 200 participants aged 60 and older, with a mean age of 69.79 years and a standard deviation of 7.19 years, using stratified proportional random sampling between May and July 2025. Each participant completed standardized questionnaires measuring three constructs: death anxiety, hope, and perceived social support. The research team, which also included Kosar Hoseini of Mazandaran University of Medical Sciences and Shahab Papi of Lorestan University of Medical Sciences, then analyzed the data using multiple linear regression and structural equation modeling, running the analyses in SPSS 24 and AMOS 24 with a significance threshold of p less than 0.05. The work was approved by the Research Ethics Committee of Mazandaran University of Medical Sciences and conducted in accordance with the Declaration of Helsinki.

Death anxiety, sometimes called thanatophobia, is far more than a fleeting worry about mortality. In older adults it has been linked to diminished quality of life, sleep disturbance, and heightened psychological distress. As people confront chronic illness, bereavement, and the narrowing of their remaining time horizon, thoughts of death can shift from abstract philosophy to concrete preoccupation. Psychologists have long noted that this anxiety is not distributed evenly: some elders face the end of life with equanimity while others are gripped by dread. Understanding what buffers that dread has therefore become a central question in geriatric mental health research.

Perceived social support, the subjective sense that one is loved, valued, and can count on others, has repeatedly emerged as a protective factor in this literature. But the Iranian team noticed a gap: while the association between support and death anxiety had been documented, the underlying mechanisms remained underexplored. Knowing that support correlates with lower anxiety tells clinicians little about where to intervene. If the relationship is direct, then simply increasing contact might suffice. If it is indirect, flowing through some intermediate psychological state, then that intermediate state becomes the real therapeutic target. The researchers hypothesized that hope, defined in the tradition of positive psychology as goal-directed thinking combining the will to pursue goals with the perceived ability to find pathways toward them, might be that crucial link.

The structural equation modeling results were striking in their clarity. Perceived social support strongly and positively predicted hope, with a standardized coefficient of 0.72 and a p-value of 0.001, indicating that elders who felt well supported reported substantially higher levels of hopeful thinking. Hope, in turn, strongly and negatively predicted death anxiety, with a standardized coefficient of negative 0.62, also at p equal to 0.001. In other words, the more hopeful the participants were, the less death anxiety they reported. These two paths together traced a coherent psychological pipeline from social connection to reduced existential distress.

The most revealing result, however, was what did not appear. The direct path from perceived social support to death anxiety was statistically negligible, with a standardized coefficient of just 0.021 and a p-value of 0.886, nowhere near significance. When the researchers bootstrapped the indirect effect, the pathway running from support through hope to death anxiety, it was significant, with a standardized coefficient of negative 0.45 and a 95 percent confidence interval spanning negative 0.70 to negative 0.21. Taken together, this pattern is consistent with full mediation: social support appears to lower death anxiety only insofar as it first builds hope. Remove hope from the model, and the protective association between support and death anxiety essentially vanishes.

For readers unfamiliar with the statistics, full mediation is a demanding standard. It does not merely show that hope plays some role alongside other mechanisms; it suggests that hope carries essentially all of the effect. The bootstrapping procedure used to test the indirect effect is considered robust because it resamples the data thousands of times to estimate the confidence interval of the mediated pathway, avoiding the distributional assumptions that can plague smaller samples. The large standardized coefficients involved, 0.72 for support predicting hope and negative 0.62 for hope predicting anxiety, are unusually strong for psychological research, where effect sizes of this magnitude are rare. That strength lends credibility to the mediation model, though it also raises questions the cross-sectional design cannot answer.

That design limitation deserves emphasis. Because all measurements were taken at a single point in time, the study can establish patterns of association but not causal direction. It is theoretically possible, for instance, that hopeful people are better at eliciting support from others, or that low death anxiety frees cognitive resources that make hopeful goal pursuit easier, creating feedback loops rather than a one-way pipeline. The authors themselves are explicit on this point, calling for future longitudinal or intervention studies to test whether deliberately cultivating hope actually reduces death anxiety over time. Only randomized trials that boost hope and track anxiety prospectively can confirm the causal chain the model implies.

Even with those caveats, the practical implications are compelling. If hope is the conduit through which social support eases existential fear, then interventions should aim at both ends of the pipeline. Strengthening social networks, through family engagement, community programs, senior centers, and regular contact with caregivers, may build the reservoir of perceived support from which hope draws. Meanwhile, hope-focused psychological interventions, such as those derived from hope therapy, goal-setting frameworks, and meaning-centered approaches used in palliative care, could directly amplify the mediating mechanism. The findings align with a broader movement in geriatric mental health that treats positive psychological resources not as luxuries but as active ingredients in resilience against mortality-related distress.

The study also carries a quiet message for families and clinicians who care for aging loved ones. Companionship matters, but the research suggests its deepest value may lie in what it makes psychologically possible: a sense that the future still holds attainable goals and navigable paths. An older adult surrounded by supportive relationships but without hope may remain vulnerable to death anxiety, while one whose hope is nurtured, whether through relationships, purpose, or structured therapy, may approach life’s final chapter with markedly less dread. As populations worldwide age rapidly, translating this insight into scalable programs for fostering hope among elders could become a meaningful public health priority. The open-access study, published on 29 September 2026 with no external funding, offers a testable roadmap for that effort, and the next phase of research will determine whether hope can be deliberately planted and grown where fear once took root.

Subject of Research: The mediating role of hope in the relationship between perceived social support and death anxiety in older adults

Article Title: Hope as a mediator in the relationship between social support and death anxiety in older adults

Article References: Zoleikani, Z., Hoseini, K., Papi, S., & Jorbonyan, A. (2026). Hope as a mediator in the relationship between social support and death anxiety in older adults. Discover Mental Health. https://doi.org/10.1007/s44192-026-00608-z

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00608-z

Keywords: death anxiety, hope, social support, older adults, aging, mental health, positive psychology, structural equation modeling, gerontology, mediation analysis, psychological well-being, anxiety

The research, published in the International Journal of Mental Health and Addiction, draws on terror management theory, a framework inspired by the cultural anthropologist Ernest Becker. According to this theory, humans cope with the terror of mortality by embedding themselves in cultural worldviews, cultivating self-esteem, and forming secure attachments to others. These psychological buffers give people a sense that they are meaningful, valued, and connected to something larger and more lasting than their individual lives. Among the most important of these defenses is symbolic immortality: the conviction that one’s name, accomplishments, or legacy will persist in the memories of others after death.

Despite the theoretical prominence of symbolic immortality, no study had ever tested whether it is systematically linked to mental health and addictive behavior. To fill this gap, a team led by Uri Lifshin of the Hebrew University of Jerusalem and the Israel Center for Addiction and Mental Health analyzed data from 2,912 Jewish Israeli adults. The sample was quasi-representative of the adult Jewish population in terms of gender, age, religiosity, and area of residence, and the data were collected in February 2025, during the Swords of Iron war—a period of acute collective threat in which mortality was anything but abstract.

Participants completed a comprehensive battery of validated instruments. Problematic substance use was assessed with the World Health Organization’s ASSIST screening test, covering alcohol, cannabis, sedatives, prescription stimulants, and opioid painkillers. Behavioral addictions were measured with established scales for gambling, problematic pornography use, sex addiction, gaming, social media, and internet use. Psychological problems were captured through the PCL-5 for post-traumatic stress, the GAD-7 for anxiety, the PHQ-9 for depression, the Pittsburgh Sleep Quality Index, and the Difficulties in Emotion Regulation Scale. Crucially, symbolic immortality was measured with a single, deceptively simple question: do you think you will be remembered by other people after you die, for example through your accomplishments or legacy?

The results were strikingly consistent. People who believed they would be remembered reported significantly higher self-esteem, greater perceived social support, stronger national identification, stronger belief in God, and a greater sense of meaning in life. They also reported lower attachment anxiety and avoidance, the two insecure dimensions of close relationships. In other words, symbolic immortality behaved exactly as terror management theory predicts a successful anxiety buffer should: it traveled alongside every major psychological resource theorized to protect people from death-related fear.

More remarkable were the associations with clinical outcomes. Stronger belief in symbolic immortality correlated with lower levels of depression, anxiety, and post-traumatic stress symptoms, as well as fewer sleep disturbances and emotion-regulation difficulties. It was also linked to less problematic use of alcohol, cannabis, and prescription drugs, and to lower severity of gambling, pornography, sex, gaming, social media, and internet addictions. These relationships held even after the researchers statistically controlled for gender, education, political orientation, military service, relationship status, parental status, and—importantly—belief in an afterlife.

That last control proved theoretically decisive. Belief in literal immortality, such as faith in heaven or reincarnation, is the religious cousin of symbolic immortality, and the two constructs were moderately correlated in the sample. Yet their psychological profiles diverged sharply. Afterlife belief was strongly tied to religiosity and belief in God but only weakly related to self-esteem, unrelated to attachment anxiety, and essentially unrelated to any measure of psychological distress. It showed only scattered negative associations with addictions and was even positively associated with problematic internet use. Symbolic immortality, by contrast, was consistently and broadly protective. Being remembered by others, it seems, does psychological work that merely believing in heaven does not.

The authors interpret these findings through the lens of anxiety buffer disruption theory, an extension of terror management theory focused on psychopathology. When core death-anxiety buffers—attachment security, self-esteem, worldview connection, and meaning in life—are chronically or acutely shattered, death-related concerns intrude into consciousness and destabilize emotional life, producing symptoms of trauma, depression, and anxiety. Addictions, in this view, can emerge as maladaptive compensatory defenses: substances and compulsive behaviors that temporarily numb existential distress when healthier buffers have failed. Prior work by the same group found that combat soldiers exposed to life-threatening situations showed more post-traumatic stress and more problematic substance use when attachment anxiety was high and ideological identification was weak. A recent meta-analysis of 104 studies likewise found moderate associations between death anxiety and a broad range of psychiatric symptoms.

Within this framework, symbolic immortality emerges as something like the positive face of a transdiagnostic risk factor. Where fragile or broken anxiety buffers leave people exposed to death anxiety and its downstream disorders, a robust sense of symbolic immortality signals that the buffering system is functioning—loved, esteemed, meaningful, and woven into a collective story that will outlast the self. The researchers are careful to note that the study does not establish symbolic immortality as an independent causal predictor separate from the other buffers; rather, it appears to be a broad indicator that multiple protective processes are operating together.

The study has clear limitations. It is correlational, so the arrows could point in either direction or both: poor mental health and addiction may erode the social bonds, self-worth, and meaning that make people feel remembered, just as much as the reverse. Symbolic immortality was captured with a single item, and future work should develop multi-item scales that distinguish immortality beliefs across life domains, from creative legacy to descendants to national belonging. The setting is also distinctive: data were gathered in Israel during an active multifront war, when mortality salience, national identity, and collective trauma were all unusually heightened, potentially amplifying the observed associations. Cross-cultural replications, ideally in peacetime populations and clinical samples, remain necessary.

Even so, the implications are provocative. Addictive behaviors of the kind studied here rarely appear in wild animals, and the authors suggest a reason: addiction may be partly rooted in the existential problems that only humans face—awareness of death, meaninglessness, and uncertainty—and in the fragile cultural technologies we use to manage them. If the sense of being remembered is one of those technologies, then interventions that strengthen legacy, belonging, and meaning may do more than comfort the dying. They may help protect the living from despair and compulsion, offering a scientifically grounded answer to a question as old as Jimi Hendrix’s castles made of sand: what, exactly, keeps the sea at bay?

Subject of Research: The association between belief in symbolic immortality and mental health problems and addictions, examined through terror management theory

Article Title: Symbolic Immortality, Mental Health, and Addictions: A Terror Management Perspective

Article References: Lifshin, U., Shmulewitz, D., Levitin, M. D., Skvirsky, V., Cherniak, A. D., & Mikulincer, M. (2026). Symbolic Immortality, Mental Health, and Addictions: A Terror Management Perspective. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-026-01720-5

Image Credits: AI Generated

DOI: 10.1007/s11469-026-01720-5

Keywords: symbolic immortality, terror management theory, death anxiety, mental health, addiction, substance use, behavioral addictions, anxiety buffer disruption, depression, PTSD, meaning in life, existential psychology